Do Waveforms Matter? Yes They Do! A Case in Point

2020 ◽  
Vol 44 (4) ◽  
pp. 192-197
Author(s):  
Jessica Kralec
Keyword(s):  
Lower Extremity ◽  
Continuous Flow ◽  
Pregnant Patient ◽  
Iliac Vein ◽  
Leg Pain ◽  
Common Iliac Vein ◽  
Venous Flow ◽  
Left Lower Extremity ◽  
Patient Reported ◽  
Spectral Doppler

A 38-year-old G1P0 presented to the Vascular Lab at 32 weeks gestation for evaluation of persistent left lower extremity edema. The patient reported a 1-month history of left leg pain and swelling after a long car trip. Of note, she had 3 negative lower extremity ultrasounds at outside imaging facilities over the previous 6 weeks. Left lower extremity venous duplex was performed with B-mode, color, power, and spectral Doppler using a linear 12-3 MHz transducer and curvilinear 5-1 MHz transducer. Images were documented using Intersocietal Accreditation Commission Vascular Testing (IAC VT) protocol. Left lower extremity duplex revealed continuous flow in the bilateral common femoral veins. Right common iliac and external iliac vein Doppler waveforms demonstrated spontaneous and phasic flow. Left proximal common iliac and external iliac veins revealed continuous flow. Acute, occlusive deep venous thrombosis (DVT) was identified in the left distal common iliac vein. The left common iliac vein was enlarged, measuring 2.2 cm compared with the contralateral common iliac vein measuring 1.4 cm. Ultrasonographic infrainguinal demonstration of acute DVT is straightforward and usually achievable with standard ICA VT protocol. However, imaging of the proximal pelvic venous circulation can be more elusive, particularly in the pregnant patient. Therefore, it is imperative to assess the spectral Doppler waveforms and to investigate pelvic venous flow. Because of the sonographer’s attention to the common femoral waveforms, additional focused pelvic imaging was performed and located acute, occlusive iliac DVT as the cause of significant edema.

scholarly journals An extensive unprovoked left lower extremity deep vein thrombosis secondary to an anatomical anomaly: a case of May-Thurner syndrome

2017 ◽  
Vol 7 (2) ◽  
Author(s):  
Irfan Ahsan ◽  
Binish G. Qureshi ◽  
Ali Raza Ghani ◽  
Faizan Malik ◽  
Zulfiqar Arif
Keyword(s):  
Lower Extremity ◽  
Young Patients ◽  
Lumbar Vertebra ◽  
Rare Condition ◽  
Iliac Vein ◽  
Young Female ◽  
The Body ◽  
Common Iliac Vein ◽  
Venous Flow ◽  
Left Lower Extremity

May-Thurner syndrome (MTS) also known as Cockett’s syndrome is a rare condition responsible for 2%-3% of all cases of deep venous thrombosis (DVT). The thrombosis results from mechanical compression of the left common iliac vein against the body of the fifth lumbar vertebra by the right common iliac artery. Repetitive hyperplasia of the venous wall by compression results in spur formation that in turn causes venous flow obstruction and results in the DVT. Our case is a young female who had acute extensive proximal DVT due to MTS that was successfully managed using mechanical thrombectomy with a venous stent. MTS although a rare entity should be suspected especially in young patients with unilateral DVT with extensive clots especially on left lower extremity without any antecedent risk factors.

Clinical correlation of anatomical location of non-thrombotic iliac vein lesion

Vascular ◽  
2016 ◽  
Vol 25 (4) ◽  
pp. 359-363 ◽  
Author(s):  
Afsha Aurshina ◽  
Borislav Kheyson ◽  
Justin Eisenberg ◽  
Anil Hingorani ◽  
Arkady Ganelin ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Intravascular Ultrasound ◽  
Iliac Vein ◽  
Clinical Findings ◽  
Common Iliac Vein ◽  
Anatomical Location ◽  
Clinical Correlation ◽  
Common Site ◽  
External Iliac Vein ◽  
Left Lower Extremity

Objective Treatment of non-thrombotic iliac vein lesions is an active area of research. Intravascular ultrasound allows its localization. We chose intravascular ultrasound to clarify the exact anatomical location of non-thrombotic iliac vein lesions and correlate it with clinical findings. Materials and methods Over seven months, we performed ilio-femoral intravascular ultrasound studies on 217 patients, in 141 women and 76 men. The average age ± standard deviation was 68 ± 14 years. We used intravascular ultrasound intraoperatively to measure the ilio-femoral veins and compared it with adjacent non-stenotic ilio-femoral veins. If more than 50% area or diameter reduction was found, it was treated with appropriate balloon and stent. Results We identified 244 lesions, 124 in left lower extremity and 120 in the right lower extremity. The most common site was the proximal common iliac vein 38.7% (22.5% females and 16.12% males) in left lower extremity and middle external iliac vein 29.16% (18.33% females and 10.83% males) in right lower extremity. The least common site was the distal external iliac vein in 3.2% (all 3.2% females) and the distal external iliac vein 7.5% (5% females and 2.5% males) in right lower extremity. Clinical correlation was noted between laterality and location of the NIVL lesion ( p < 0.0001). Conclusion This analysis gives an insight into understanding the exact anatomical locations of the non-thrombotic iliac vein lesions helping clinicians and researchers guide their treatment and research.

scholarly journals Sonography’s Role in the Diagnosis of May–Thurner Syndrome

2017 ◽  
Vol 34 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Ashley Barry
Keyword(s):  
Lower Extremity ◽  
Iliac Vein ◽  
Postthrombotic Syndrome ◽  
Venous Disease ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Anatomic Variant ◽  
Left Lower Extremity ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome

May–Thurner syndrome (MTS), also known as Cockett syndrome or iliac vein compression syndrome, is a condition in which patients develop swelling, deep vein thrombosis (DVT), venous insufficiency, and other symptoms of the left lower extremity due to an anatomic variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. Although it is an uncommonly diagnosed condition, it is estimated to compose up to half of cases of left lower extremity venous disease. Although having some degree of iliac vein compression is considered a normal anatomic variant in an asymptomatic patient, those who experience severe swelling, venous reflux, and DVT often have anatomically abnormal veins with a spur formation. With proper technique and proficiency, transabdominal sonography can be used as a valuable diagnostic tool in the discovery and to facilitate treatment of May–Thurner syndrome. Diagnostic ultrasound also can monitor the development of recurring DVT and identify symptoms of postthrombotic syndrome.

scholarly journals Case Report: Rare Iliac Vein Compression (May–Thurner) Syndrome in a Pediatric Patient

2021 ◽  
Vol 9 ◽  
Author(s):  
Lianfu Ji ◽  
Fan Yang ◽  
Xuan Chen ◽  
Jinlong Chen ◽  
Xueying Cheng ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein ◽  
Left Lower Extremity ◽  
Normal Ranges ◽  
Iliac Vein Compression ◽  
Magnetic Resonance Imaging Mri ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Iliac vein compression syndrome (IVCS) or May–Thurner syndrome occurs predominantly in young to middle-aged women. Here we reported a case of IVCS in a 5-year-old boy. The child was admitted to our vasculocardiology department with left lower extremity that had been swollen for 1 month. Blood tests revealed coagulation routine and platelets in the normal ranges. Computer tomography angiography (CTA) and magnetic resonance imaging (MRI) showed the left common iliac vein had become narrow before it entered the right common iliac vein. To further clarify, we performed angiography, which clearly showed the stenosis and the blood return of the left common iliac vein. So IVCS was diagnosed. What is more, we found the aorta descended to the right of the spine, and this may be the reason for the apparent compression of the left common iliac vein. Given the young age and mild symptoms of the child, the treatment was conservative mainly including elevation of the affected limb, wearing medical elastic socks, and short-term oral aspirin for anticoagulation. Meanwhile, the boy is being followed up closely. If the swelling of the left lower extremity significantly increases, stent placement may need to be considered in the future.

Case Series of Concomitant Klippel-Trenaunay Syndrome and May-Thurner Syndrome

2021 ◽  
pp. 153857442199501
Author(s):  
John F. Charitable ◽  
Onur Yilmaz ◽  
Caron Rockman ◽  
Glenn R. Jacobowitz
Keyword(s):  
Lower Extremity ◽  
Case Series ◽  
Iliac Vein ◽  
Symptomatic Improvement ◽  
Venous Disease ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein ◽  
Left Lower Extremity ◽  
The Right ◽  
Klippel Trenaunay Syndrome

Klippel-Trenaunay syndrome is a rare vascular disorder which includes leg swelling, or lower extremity deep venous reflux/thrombosis as a presenting symptom. May-Thurner syndrome is also a rare pathology involving compression of the left common iliac vein, usually by the right common iliac artery. The incidence of concomitant occurrence of these entities is unknown and not well reported. This case series describes 3 patients who underwent evaluation of symptomatic left lower extremity venous disease. All 3 suffered symptomatic Klippel-Trenaunay initially, and were subsequently diagnosed with concomitant May-Thurner Syndrome. They were successfully treated with left common iliac vein stents with symptomatic improvement.

Correlation of the Diameter of the Left Common Iliac Vein with the Risk of Lower-extremity Deep Venous Thrombosis

2012 ◽  
Vol 23 (11) ◽  
pp. 1467-1472 ◽  
Author(s):  
Stephanie Carr ◽  
Keith Chan ◽  
Jarrett Rosenberg ◽  
William T. Kuo ◽  
Nishita Kothary ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein

scholarly journals Peripheral and Neuraxial Chemical Neurolysis for the Management of Intractable Lower Extremity Pain in a Patient with Terminal Cancer

2015 ◽  
Vol 18;4 (4;18) ◽  
pp. E651-E656 ◽  
Author(s):  
Mario De Pinto
Keyword(s):  
Pain Relief ◽  
Lower Extremity ◽  
Cancer Pain ◽  
Femoral Nerve ◽  
Stage Iv ◽  
Left Lower Extremity ◽  
Complete Pain Relief ◽  
Adequate Pain Relief ◽  
Patient Reported ◽  
Intractable Cancer Pain

We present the case of a 74-year-old man with Stage IV metastatic, multifocal, malignant fibrous histiocytoma (T2b, N1, M1, G4) invading the proximal area of the left lower extremity and resulting in intractable neuropathic pain along the distribution of the femoral nerve. He described the pain as being so severe to cause inability to ambulate without assistance or to sleep in a supine or prone position. After a spinal cord stimulation trial and a trial of intrathecal (IT) hydromorphone, both performed at an outside institution, had failed to achieve adequate pain relief, we decided to perform a femoral nerve chemical neurolysis with phenol under ultrasound (US) guidance. The intervention provided 6 months of almost complete pain relief. With the tumor spreading in girth distally and proximally to the scrotal and pelvic areas as well as to the lungs, and pain returning back to baseline, we proceeded with a second femoral nerve chemical neurolysis. Unfortunately we were not able to achieve adequate pain relief. Therefore we opted to proceed with a diagnostic injection of local anesthetic under fluoroscopic guidance at the left L2, L3, and L4 nerve roots level. This intervention provided 100% pain relief and was followed, a few days later, by chemical neurolysis with phenol 3%. The patient reported complete pain relief with the procedure and no sensory-motor related side effects or complications. He was able to enjoy the last 6 weeks of life with his wife and family, pain-free. With this report we add to the limited literature available regarding the management of intractable cancer pain with chemical neurolysis in and around the epidural space. Key words: Cancer, pain, chemical neurolysis, peripheral, neuraxial

Unusual cases of right-sided and left-sided May–Thurner syndrome

2014 ◽  
Vol 25 (4) ◽  
pp. 797-799 ◽  
Author(s):  
I. B. Vijayalakshmi ◽  
H. S. Natraj Setty ◽  
Chitra Narasimhan
Keyword(s):  
Aortic Stenosis ◽  
Rare Case ◽  
Common Iliac Artery ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Rare Clinical Entity ◽  
Venous Obstruction ◽  
Left Common Iliac Vein ◽  
Left Lower Extremity ◽  
The Right

AbstractMay–Thurner syndrome is a rare clinical entity involving venous obstruction of the left lower extremity. The May–Thurner syndrome is a phenomenon commonly described as an acquired stenosis of the left common iliac vein secondary to compression of the left common iliac vein between the right common iliac artery and the underlying vertebral body. We report one case of May–Thurner syndrome, and another rare case of reverse May–Thurner syndrome, incidently detected during intervention, in a case of aortic stenosis and mitral stenosis with dextrocardia and situs inversus.

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